Grantham Research Institute for Climate Change and the Environment, London School of Economics and Political Science, London, UK.
International Research Institute for Climate and Society, Columbia University, Palisades, NY, USA.
Malar J. 2021 Apr 17;20(1):190. doi: 10.1186/s12936-021-03718-x.
Two recent initiatives, the World Health Organization (WHO) Strategic Advisory Group on Malaria Eradication and the Lancet Commission on Malaria Eradication, have assessed the feasibility of achieving global malaria eradication and proposed strategies to achieve it. Both reports rely on a climate-driven model of malaria transmission to conclude that long-term trends in climate will assist eradication efforts overall and, consequently, neither prioritize strategies to manage the effects of climate variability and change on malaria programming. This review discusses the pathways via which climate affects malaria and reviews the suitability of climate-driven models of malaria transmission to inform long-term strategies such as an eradication programme. Climate can influence malaria directly, through transmission dynamics, or indirectly, through myriad pathways including the many socioeconomic factors that underpin malaria risk. These indirect effects are largely unpredictable and so are not included in climate-driven disease models. Such models have been effective at predicting transmission from weeks to months ahead. However, due to several well-documented limitations, climate projections cannot accurately predict the medium- or long-term effects of climate change on malaria, especially on local scales. Long-term climate trends are shifting disease patterns, but climate shocks (extreme weather and climate events) and variability from sub-seasonal to decadal timeframes have a much greater influence than trends and are also more easily integrated into control programmes. In light of these conclusions, a pragmatic approach is proposed to assessing and managing the effects of climate variability and change on long-term malaria risk and on programmes to control, eliminate and ultimately eradicate the disease. A range of practical measures are proposed to climate-proof a malaria eradication strategy, which can be implemented today and will ensure that climate variability and change do not derail progress towards eradication.
最近的两项倡议，世界卫生组织（WHO）疟疾消除战略咨询小组和柳叶刀疟疾消除委员会，评估了实现全球疟疾消除的可行性，并提出了实现这一目标的策略。这两份报告都依赖于疟疾传播的气候驱动模型，得出的结论是，气候的长期趋势将总体上有助于消除工作，因此都没有优先考虑应对气候变化对疟疾规划影响的策略。这篇综述讨论了气候影响疟疾的途径，并审查了疟疾传播的气候驱动模型在为长期战略（如消除规划）提供信息方面的适用性。气候可以直接通过传播动力学影响疟疾，也可以通过包括支撑疟疾风险的许多社会经济因素在内的多种途径间接影响疟疾。这些间接影响在很大程度上是不可预测的，因此不包括在气候驱动疾病模型中。这些模型在预测未来几周到几个月的传播方面非常有效。然而，由于几个有据可查的限制，气候预测无法准确预测气候变化对疟疾的中期或长期影响，特别是在地方层面。长期气候趋势正在改变疾病模式，但气候冲击（极端天气和气候事件）和亚季节到十年时间范围内的可变性对疾病的影响比趋势大得多，也更容易纳入控制计划。鉴于这些结论，提出了一种务实的方法来评估和管理气候变异性和变化对长期疟疾风险以及控制、消除和最终根除疾病的规划的影响。提出了一系列实用措施来为疟疾消除策略提供气候适应能力，这些措施可以今天实施，并确保气候变异性和变化不会破坏根除工作的进展。
